Mortality in Patients With Left Ventricular Ejection Fraction ≤30% After Primary Percutaneous Coronary Intervention for ST-Elevation Myocardial Infarction

• Published in: The American journal of cardiology Vol. 100; no. 5; pp. 793 - 797
• Main Authors: Ottervanger, Jan Paul, MD, PhD, Ramdat Misier, Anand R., MD, PhD, Dambrink, Jan-Henk E., MD, PhD, de Boer, Menko-Jan, MD, PhD, Hoorntje, Jan C.A., MD, PhD, Gosselink, A.T. Marcel, MD, PhD, Suryapranata, Harry, MD, PhD, Reiffers, Stoffer, PhD, van ‘t Hof, Arnoud W.J., MD, PhD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.09.2007; Elsevier; Elsevier Limited
• Subjects: Aged; Angioplasty, Balloon, Coronary; Biological and medical sciences; Cardiac Output, Low - mortality; Cardiology. Vascular system; Cardiovascular; Cardiovascular Agents - therapeutic use; Cardiovascular system; Clinical trials; Coronary Disease - mortality; Coronary heart disease; Death, Sudden, Cardiac; Defibrillators; Diseases of the cardiovascular system; Electrocardiography; Female; Follow-Up Studies; Heart; Heart attacks; Humans; Investigative techniques of hemodynamics; Investigative techniques, diagnostic techniques (general aspects); Length of Stay - statistics & numerical data; Male; Medical sciences; Medical treatment; Middle Aged; Mortality; Myocardial Infarction - mortality; Myocardial Infarction - therapy; Myocarditis. Cardiomyopathies; Netherlands - epidemiology; Prospective Studies; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Recurrence; Survival Rate; Ventricular Dysfunction, Left - mortality; Netherlands; Human; Myocardial infarction; Prognosis; Angioplasty; Mortality; Coronary artery; Instrumentation therapy; Cardiovascular disease; Patient; Myocardial disease; Coronary heart disease; Epidemiology; Phlebology; Stent; Left ventricle; ST elevation; Primary; Ventricular ejection; Circulatory system; Hemodynamics; Cardiology; Ejection fraction
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2007.03.101

Decreased left ventricular (LV) function is a strong predictor of mortality. Although current guidelines recommend prophylactic implantable cardioverter-defibrillator (ICD) implantation after ST-elevation myocardial infarction and a depressed LV ejection fraction for 1 month, the prognoses of these patients may be better than those observed in randomized trials of ICDs (1-year mortality 6.8% to 19%), particularly because reperfusion treatment has improved, and the use of life-saving drugs is higher. To assess 1-year mortality in patients with depressed LV ejection fractions after primary percutaneous coronary intervention, a prospective, observational study was performed. Data from all patients who survived ≥30 days after primary percutaneous coronary intervention and had LV ejection fractions ≤30% from 1994 to 2004 were recorded. Of 2,544 patients, 342 (13%) had LV ejection fractions ≤30%. One-year mortality was 5.8%. Sudden death was the most common cause of death (40%). Patients who died more often had multivessel disease and a higher incidence of recurrent myocardial infarction within 1 year. In conclusion, current mortality in patients with depressed LV ejection fractions after primary percutaneous coronary intervention is much better than that observed in previous ICD trials, and the benefits of ICD therapy in these patients should be further evaluated.